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Demographics, patterns of care, and survival in pediatric medulloblastoma

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Abstract

We evaluated the American College of Surgeon’s National Cancer Data Base (NCDB) to describe current hospital-based epidemiologic frequency, survival, and patterns of care of pediatric medulloblastoma. We analyzed NCDB 1998–2011 data on medulloblastoma for children ages 0–19 years using logistic and poisson regression, Kaplan–Meier survival estimates, and Cox proportional hazards models. 3647 cases of medulloblastoma in those aged 0–19 years were identified. Chemotherapy was received by 79 and 74% received radiation, with 65% receiving both therapies. Those who received radiation were more likely to be older than four, while those who received chemotherapy were more likely to be age four and younger. Variables associated with receipt of neither radiation nor chemotherapy included age at diagnosis of <1 year, female gender, being of race other than black or white, having no insurance, and living in a residential area with a low level of high school graduates. Better overall survival was observed as age at diagnosis increased, in females, and having received radiation. Compared to medulloblastoma, NOS, better survival was observed for those with demoplastic medulloblastoma, with worse survival in those with large cell medulloblastoma. Majority received multi- disciplinary therapy and radiation had the greatest effect on survival. Ages four and under were most likely to receive chemotherapy and least likely to receive radiation. Suboptimal treatment included 17.8% that did not receive chemotherapy, of which 11.8% received neither chemotherapy nor radiation. Disparities associated with medical access were characteristics for not receiving standard treatment, which resulted in poor outcome.

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Acknowledgements

We are grateful to Bridget J. McCarthy, Ph.D. for being a resource for ideas and inspiration as well as providing extremely helpful comments on the manuscript. We would also like to thank Cynthia Phelan, M.D. for critically reviewing the manuscript.

Funding

EVD, TAD, and JLV were supported by the National Cancer Institute (R03CA156561) and EVD is a member of the Biostatistics and Bioinformatics Shared Resource Facility of the University of Kentucky Markey Cancer Center (P30CA177558).

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Authors and Affiliations

  1. Division of Cancer Biostatistics (EVD, ML) and Departments of Medicine and Neurology (JLV), University of Kentucky, 800 Rose St., CC446, Lexington, KY, 40536-0093, USA

    Emily V. Dressler, Meng Liu & John L. Villano

  2. Division of Epidemiology and Biostatistics and Institute for Health Research and Policy, School of Public Health (TAD), University of Illinois at Chicago, Chicago, IL, USA

    Therese A. Dolecek

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  1. Emily V. Dressler
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Correspondence to John L. Villano.

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Dressler, E.V., Dolecek, T.A., Liu, M. et al. Demographics, patterns of care, and survival in pediatric medulloblastoma. J Neurooncol 132, 497–506 (2017). https://doi.org/10.1007/s11060-017-2400-5

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